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176 1st Avenue North Iiwaco WA 98624-0319 | |
(360) 642-3747 | |
(360) 642-3361 |
Full Name | |
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Speciality | Clinic/Center |
Location | 176 1st Avenue North, Iiwaco, Washington |
Authorized Official Name and Position | Larry Cohen (CEO) |
Authorized Official Contact | 3606426300 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box N Iiwaco WA 98624-0319 Ph: (360) 642-3747 | 176 1st Avenue North Iiwaco WA 98624-0319 Ph: (360) 642-3747 |
NPI Number | 1639165905 |
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Provider Enumeration Date | 09/22/2005 |
Last Update Date | 03/12/2019 |
Medicare PECOS PAC ID | 7214822105 |
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Medicare Enrollment ID | O20041119000763 |
Identifier | Type | State | Issuer |
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1639165905 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |